Michigan Sample Letter for Termination of Physician's Care - Patient to Physician

• Category: Letters - Nonlegal - Termination
• State: Multi-State
• Control #: US-0237LR
• Format: Word; Rich Text

Description

This form is a sample letter in Word format covering the subject matter of the title of the form. Subject: Termination of Physician's Care — Patient to Physician: Michigan Sample Letter Dear [Physician's Name], I hope this letter finds you well. I am writing to inform you about my decision to terminate our physician-patient relationship effective immediately. After careful consideration, I have come to the conclusion that it is in my best interest to seek medical care elsewhere. I would like to thank you for the care you have provided to me thus far. I appreciate the medical expertise and attention you have shown, but due to personal reasons, I believe a change in healthcare provider is necessary at this time. Please understand that this decision is not based on any dissatisfaction with the level of care or expertise you have demonstrated, but rather focuses on my preference for a different medical approach or compatibility with another provider. As per Michigan law, I am entitled to choose the healthcare provider that best suits my needs and feel it is my responsibility to exercise this right. I trust that you understand and respect this decision in accordance with professional ethics. To ensure a smooth transition, I kindly request the following actions from you: 1. Please forward a copy of my medical records, including any test results, diagnoses, and treatment plans to the address provided below. I understand that there may be specific procedures and fees associated with obtaining these documents, and I am prepared to fulfill any necessary requirements. 2. If there are any pending appointments scheduled, kindly cancel them on my behalf. Additionally, if there are any prescriptions that require refill authorization or ongoing management, I kindly request you provide me with a reasonable supply of medication until I am able to establish care with a new physician. 3. Please confirm the termination of our physician-patient relationship in writing, either by responding to this letter or by sending a separate communication indicating the termination. This will assist me in documenting the end of our professional association. Please note that this termination of care does not affect my gratitude towards the care I have received from you in the past. I appreciate your understanding and cooperation during this transitional period. Should you require any additional information or have any questions regarding this matter, please do not hesitate to contact me at [your contact information]. I kindly request a prompt response to this letter to ensure a seamless transfer of medical records. Thank you once again for your care and assistance. Sincerely, [Your Name] [Your Address] [City, State, ZIP] [Date] --- Types of Michigan Sample Letters for Termination of Physician's Care — Patient to Physician: 1. Termination of Physician's Care — Patient to Physician: Michigan Sample Letter (General) 2. Termination of Physician's Care — Patient to Physician: Michigan Sample Letter (Request for Medical Records) 3. Termination of Physician's Care — Patient to Physician: Michigan Sample Letter (Request for Prescription Refills) 4. Termination of Physician's Care — Patient to Physician: Michigan Sample Letter (Request for Appointment Cancellation) 5. Termination of Physician's Care — Patient to Physician: Michigan Sample Letter (Confirmation of Termination)

Subject: Termination of Physician's Care — Patient to Physician: Michigan Sample Letter Dear [Physician's Name], I hope this letter finds you well. I am writing to inform you about my decision to terminate our physician-patient relationship effective immediately. After careful consideration, I have come to the conclusion that it is in my best interest to seek medical care elsewhere. I would like to thank you for the care you have provided to me thus far. I appreciate the medical expertise and attention you have shown, but due to personal reasons, I believe a change in healthcare provider is necessary at this time. Please understand that this decision is not based on any dissatisfaction with the level of care or expertise you have demonstrated, but rather focuses on my preference for a different medical approach or compatibility with another provider. As per Michigan law, I am entitled to choose the healthcare provider that best suits my needs and feel it is my responsibility to exercise this right. I trust that you understand and respect this decision in accordance with professional ethics. To ensure a smooth transition, I kindly request the following actions from you: 1. Please forward a copy of my medical records, including any test results, diagnoses, and treatment plans to the address provided below. I understand that there may be specific procedures and fees associated with obtaining these documents, and I am prepared to fulfill any necessary requirements. 2. If there are any pending appointments scheduled, kindly cancel them on my behalf. Additionally, if there are any prescriptions that require refill authorization or ongoing management, I kindly request you provide me with a reasonable supply of medication until I am able to establish care with a new physician. 3. Please confirm the termination of our physician-patient relationship in writing, either by responding to this letter or by sending a separate communication indicating the termination. This will assist me in documenting the end of our professional association. Please note that this termination of care does not affect my gratitude towards the care I have received from you in the past. I appreciate your understanding and cooperation during this transitional period. Should you require any additional information or have any questions regarding this matter, please do not hesitate to contact me at [your contact information]. I kindly request a prompt response to this letter to ensure a seamless transfer of medical records. Thank you once again for your care and assistance. Sincerely, [Your Name] [Your Address] [City, State, ZIP] [Date] --- Types of Michigan Sample Letters for Termination of Physician's Care — Patient to Physician: 1. Termination of Physician's Care — Patient to Physician: Michigan Sample Letter (General) 2. Termination of Physician's Care — Patient to Physician: Michigan Sample Letter (Request for Medical Records) 3. Termination of Physician's Care — Patient to Physician: Michigan Sample Letter (Request for Prescription Refills) 4. Termination of Physician's Care — Patient to Physician: Michigan Sample Letter (Request for Appointment Cancellation) 5. Termination of Physician's Care — Patient to Physician: Michigan Sample Letter (Confirmation of Termination)